TBRQ Ch: 41 - Oxygenation Flashcards
For which of the following health problems is a patient who has a 40-year history of smoking at risk?
- Alcoholism and hypertension
- Obesity and diabetes
- Stress-related illnesses
- Cardiopulmonary disease and lung cancer
Answer: 4.
Effects of nicotine on blood vessels and lung tissue have increasing pathological effects on the cardiovascular and pulmonary systems.
A patient has been diagnosed with severe iron deficiency anemia. During physical assessment, which of the following symptoms are associated with decreased oxygenation as a result of the anemia?
- Increased breathlessness but increased activity tolerance
- Decreased breathlessness and decreased activity tolerance
- Increased activity tolerance and decreased breathlessness
- Decreased activity tolerance and increased breathlessness
Answer: 4.
Hypoxia occurs due to decreased hemoglobin, which leads to decreased oxygen to muscles, causing fatigue and decreased activity tolerance as well as a feeling of shortness of breath.
A patient is admitted to the emergency department with suspected carbon monoxide poisoning. Even though the patient’s color is ruddy and not cyanotic, the nurse understands the patient is at a risk for decreased oxygen-carrying capacity of blood because carbon monoxide does which of the following:
- Stimulates hyperventilation, causing respiratory alkalosis
- Forms a strong bond with hemoglobin, thus preventing oxygen binding in the lungs
- Stimulates hypoventilation, causing respiratory acidosis
- Causes alveoli to overinflate, leading to atelectasis
Answer: 2.
Carbon monoxide strongly binds to hemoglobin, making it unavailable for oxygen binding and transport.
An 86-year-old woman is admitted to the unit with chills and a fever of 104° F. What physiological process explains why she is at risk for dyspnea?
- Fever increases metabolic demands, requiring increased oxygen need.
- Blood glucose stores are depleted and the cells do not have energy to use oxygen.
- Carbon dioxide production increases due to hyperventilation.
- Carbon dioxide production decreases due to hypoventilation.
Answer: 1.
When the body cannot meet the increased oxygenation need, the increased metabolic rate causes breakdown of protein and wasting of respiratory muscles, increasing the work of breathing.
A patient is admitted with the diagnosis of severe left-sided heart failure. What adventitious lung sounds are expected on auscultation?
- Sonorous wheezes in the left lower lung
- Rhonchi mid sternum
- Crackles only in apex of lungs
- Inspiratory crackles in lung bases
Answer: 4.
Decreased effective contraction of left side of heart leads to back up of fluid in the lungs, increasing hydrostatic pressure and causing pulmonary edema.
The nurse is caring for a patient who has decreased mobility. Which intervention is a simple and cost-effective method for reducing the risks of pulmonary complication?
- Antibiotics
- Frequent change of position
- Oxygen humidification
- Chest physiotherapy
Answer: 2.
Movement not only mobilizes secretions but helps strengthen respiratory muscles by impacting the effectiveness of gas exchange processes.
A patient is admitted with severe lobar pneumonia. Which of the following assessment findings would indicate that the patient needs airway suctioning?
- Coughing up sputum occasionally
- Coughing up thin, watery sputum after nebulization
- Decreased ability to clear airway through coughing
- Lung sounds clear only after coughing
Answer: 3.
Impaired ability to cough up mucus due to weakness or very thick secretions indicates a need for suctioning.
A patient was admitted following a motor vehicle accident with multiple fractured ribs. Respiratory assessment includes signs/symptoms of secondary pneumothorax. Which are the most common assessment findings associated with a pneumothorax? (Select all that apply.)
- Sharp pleuritic pain that worsens on inspiration
- Crackles over lung bases of affected lung
- Tracheal deviation toward the affected lung
- Worsening dyspnea
- Absent lung sounds to auscultation on affected side
Answer: 1, 4, 5.
When the lung collapses, as with a pneumothorax, the thoracic space fills with air, which irritates the parietal pleura causing inspiratory pain. Because of the collapsed lung there is reduced gas exchange in the affected area, reduced oxygenation and dyspnea result. When an area of the lung collapses, breath sounds over affected area are absent.
A patient has been newly diagnosed with chronic lung disease. In discussing the lung disease with the nurse, which of the patient’s statements would indicate a need for further education?
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1. “I’ll make sure that I rest between activities so I don’t get so short of breath.”
2. “I’ll practice the pursed-lip breathing technique to improve my exercise tolerance.”
3. “If I have trouble breathing at night, I’ll use two or three pillows to prop up.”
4. “If I get short of breath, I’ll turn up my oxygen level to 6 L/min.”
Answer: 4.
Hypoxia is the drive to breathe in a COPD patient who has become used to acidic pH and elevated CO2 levels. Turning up to 6 L/min will increase oxygen level, which turns off the drive to breathe.
The nurse assesses a new patient and finds the patient short of breath with a respiratory rate of 32 and lying supine in bed. What is the priority nursing action?
- Raise the head of the bed to 45 degrees or higher.
- Get the oxygen saturation with a pulse oximeter.
- Take the blood pressure and respiratory rate.
- Notify the health care provider of the shortness of breath.
Answer: 1.
Raising the head of the bed will bring the diaphragm down and allow for better chest expansion, thus improving oxygenation.
The nurse is caring for a patient who exhibits labored breathing, is using accessory muscles, and is coughing up pink frothy sputum. The patient has diminished breath sounds in bilateral lung bases. What are the priority nursing assessments for the nurse to perform prior to notifying the patient’s health care provider? (Select all that apply.)
- SpO2 levels
- Amount, color, and consistency of sputum production
- Fluid status
- Change in respiratory rate and pattern
- Pain in lower leg
Answer: 1, 2, 4.
These are key respiratory assessments that provide data on patient’s worsening respiratory status. While fluid status does impact respiratory status, it is not a priority assessment at this time. Pain in lower leg is assessed later.
Place the following in correct sequence for suctioning a patient.
- Open kit and basin
- Apply gloves
- Lubricate catheter
- Verify functioning of suction device and pressure
- Connect suction tubing to suction catheter
- Increase supplemental oxygen
- Reapply oxygen
- Suction airway
Answer: 4, 6, 1, 3, 2, 5, 8, 7.
These steps allow for smooth completion of procedure while helping to maintain patient’s level of oxygenation.
Which of the following skills can the nurse delegate to nursing assistive personnel (NAP)? (Select all that apply.)
- Nasotracheal suctioning
- Oropharyngeal suctioning of a stable patient
- Suctioning a new artificial airway
- Permanent tracheostomy tube suctioning
Answer: 2, 4.
Oropharyngeal suctioning of a stable patient and permanent tracheostomy tube suctioning may be safely delegated to a NAP. The other skills require nursing assessment and clinical decision making as the skill progresses.
Two hours after surgery, the nurse assesses a patient who had a chest tube inserted during surgery. There is 200 ml of dark red drainage in the chest tube at this time. What is the appropriate action for the nurse to perform?
- Record the amount and continue to monitor drainage.
- Notify the physician.
- Strip the chest tube starting at the chest.
- Increase the suction by 10 mm Hg.
Answer: 1.
Dark red drainage after surgery (50 to 200 mL per hour in first 3 hours) is expected but be aware of sudden increases greater than 100 mL per hour after the first 3 hours, especially if becomes bright red in color.
The nurse is reviewing the results of the patient’s diagnostic testing. Of the following results, the finding that falls within expected or normal limits is:
- Palpable, elevated hardened area around a tuberculosis skin testing site
- Sputum for culture and sensitivity identifies mycobacterium tuberculosis
- Presence of acid-fast bacilli in sputum
- Arterial oxygen tension (PaO2) of 95 mm Hg
Answer: 4.
A palpable, elevated, hardened area surrounding a tuberculosis skin testing site is indicative of an antigen-antibody reaction and is considered a positive skin test. Sputum for culture and sensitivity noted the presence of an organism and acid fast bacilli. Normal arterial oxygen tension (PaO2) ranges between 95-100 mm Hg).
